Indiana University-Purdue University Indianapolis (IUPUI) / Formal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.

<p>Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (<i>n </i>= 16; PANSS conceptual disorganization ≥ 3) and non-FTD (<i>n</i> = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition. </p>

<p>Formal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD. </p>

Indiana University-Purdue University Indianapolis (IUPUI) / Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (n = 16; PANSS conceptual disorganization ≥ 3) and non-FTD (n = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition.

Formal thought disorder (FTD), or disorganized speech, is one of the central signs of schizophrenia; however, little is known about the etiology of FTD. To identify new genetic loci associated with FTD, we conducted the first genome-wide association meta-analysis of two datasets of 835 cases of FTD and 2,694 controls with 729,454 single-nucleotide polymorphisms (SNPs). Logistic regression analysis of FTD as a binary trait, adjusted for age and sex, was performed using PLINK. For meta-analysis of two datasets, the fixed-effect model in PLINK was applied. Through meta-analysis we identified 61 SNPs associated with FTD with p < 10-4. The most significant association with FTD was observed with rs1783925 (p = 4.4 × 10-7) within PKNOX2 gene at 11q24.2 while the second interesting locus was rs2277644 (p = 1.18 × 10-5) within MYH13 at 17p13. Haplotype analyses of PKNOX2 and MYH13 loci further supported the associations with FTD. The third locus was PHF2 at 9q22.31 (the top SNP was rs12238738 with p = 2.08 × 10-5) while the fourth locus was GPC6 at 13q32 (the top SNP was rs17196161 with p = 3.12 × 10-5). In conclusion, we identified four new loci (PKNOX2, MYH13, PHF2, and GPC6) associated with FTD. These findings offer the potential for new insights into the pathogenesis of FTD and schizophrenia.

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[pt] Esta dissertação é um estudo experimental que busca investigar a construção da referência de expressões nominais inseridas em contextos discursivos. Um dos objetivos foi analisar se falantes nativos do português brasileiro fazem uso de informações dadas no contexto para interpretação de expressões nominais definidas. O outro objetivo foi verificar em que medida presença de traços de personalidade esquizotípica em falantes normais interfere na integração de informações contextuais na construção da referência. Para realizar a investigação, foi conduzido um teste de linguagem acompanhado de dois questionários psicométricos para medir traços gerais de personalidade esquizotípica e traços de desordens do pensamento. O experimento foi conduzido com adultos universitários do Rio de Janeiro. Os resultados indicam que no geral os falantes do português brasileiro têm preferência por interpretar uma expressão nominal definida como se referindo a uma única entidade, mas são sensíveis às informações dadas no contexto, de modo que a referência de uma expressão nominal definida pode ser uma classe de indivíduos quando o contexto fornece informações ostensivas nessa direção. Correlações entre os resultados do teste de linguagem e os resultados dos questionários psicométricos sugerem que falantes com baixas habilidades para conversas e afeto constrito apresentam possibilidades interpretativas mais restritas, especialmente quando o contexto favorece referência a um único individuo. Embora, a investigação conduzida sobre a relação entre linguagem e esquizotipia seja preliminar, os resultados encontrados indicam possíveis interferências de traços de personalidade esquizotípica na construção da referência pela linguagem. / [en] This thesis is an experimental study to investigate how the reference of nominal expressions is built within a discourse context. The first goal was to analyze how native speakers of Brazilian Portuguese use contextual information in interpreting definite descriptions. The second goal was to determine whether or not traces of schizotypal personality can interfere in the integration of contextual information in building reference. The linguistic experimental study was accompanied by two psychometric scales. The psychometric scales were used to measure general traits of schizotypal personality and thought disorders. The participants in the experiment were adult native speakers of Brazilian Portuguese from Rio de Janeiro, and the results showed that in general the participants had a significant preference for interpreting a definite description as referring to a single entity. However, they were sensitive to contextual information and reference to a group of entities (king reading) was licensed when the context was favorable. Correlations between the linguistic results and the results of the psychometric scales suggest that speakers with low conversational ability and constricted affect are more restrictive in their interpretation choices, displaying a greater preference for reference to a single entity, especially in contexts favoring single entity reference. Although this is a preliminary investigation, our experimental findings indicate that traits of schizotypy can interfere in how reference is built within language.

The characteristics of patient speech are used in clinical settings to make assumptions about the thought processes of people with psychotic disorders such as schizophrenia. However, there have not been any studies of the language of people with schizophrenia that present evidence drawn from a large group of speakers. This study employs a combination of quantitative and qualitative methods to determine whether 140 medicated individuals diagnosed with schizophrenia exhibit the linguistic abnormalities claimed in the literature. It also compares the speech of people with schizophrenia with that of people diagnosed with depression in order to assess whether there is a statistically significant difference in presence and/or frequency of abnormal speech between the two groups. Ultimately this study finds that all of the specific types of abnormal language behavior described in the literature do occur among a large group of individuals with schizophrenia. However, many such behaviors also occur among individuals with depression; there was a significant difference between the two groups for three of the twelve categories of language features assessed in this study, which were peculiar word choice, illogicality and distractibility. Further characteristics of the language of individuals with schizophrenia were also found, which could be a basis for improving clinical diagnostic materials.